Leberresektion bei nicht kolorektalen, nicht neuroendokrinen Lebermetastasen – ist die Resektion im Rahmen des „onko-chirurgischen“ Therapiekonzeptes gerechtfertigt?

Abstract

The value of hepatic resection for non-colorectal, non-neuroendocrine liver metastases remains controversial and is still under debate. Although there are numerous reported cases, the results are inconsistent due to the heterogeneity of the enrolled patients. The aim of the present study was to determine the utility of liver resection in the long-term outcome of patients with non-colorectal, non-neuroendocrine liver metastases and to define prognostic factors predicting long-term survivors. The records of patients undergoing liver resection for non-colorectal, non-neuroendocrine liver metastases between January 1994 and December 2008 were analysed. Patient demographics, tumour characteristics, type of resection, long-term outcome and prognostic factors were analysed. Between 1994 and December 2008 273 liver resections were performed in 242 patients because of non-colorectal, non-neuroendocrine liver metastases. The morbidity rate was 20.9 % (n = 57), the mortality rate was 2.2 % (n = 6). Patient survival at 1, 3, 5 and 10 years was 76 %, 42 %, 28 % and 13 %, respectively. In multivariate analyses margin status (R0 vs. R2; p = 0.001) and time to metastases (synchronous vs. metachronous) were predictors of survival. Patient's age, type of resection, number and size of metastases did not achieve significance. According to the primary tumour site, patient survival differed. Patients with urological and gynaecological primary tumours fared better whereas patients with liver metastases from gastrointestinal primary tumours did worse without reaching statistical significance. Liver resection for non-colorectal, non-neuroendocrine liver metastases is safe and effective. For individual patients with controlled systemic disease, liver resection can offer appropriate survival rates and should be a part of the onco-surgical treatment.